Provider Demographics
NPI:1891796330
Name:LYERLY, RICKY DUANE (MD)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:DUANE
Last Name:LYERLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-1430
Mailing Address - Country:US
Mailing Address - Phone:336-629-6565
Mailing Address - Fax:336-626-5640
Practice Address - Street 1:364 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5434
Practice Address - Country:US
Practice Address - Phone:336-629-6565
Practice Address - Fax:336-626-5640
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133N2Medicaid
NC16-01203OtherUNITED HEALTHCARE
NC133N2OtherBLUE CROSS BLUE SHIELD
NC2292997Medicare ID - Type Unspecified
NC89133N2Medicaid